NYC Rhinoplasty Surgeon, Dr. Sam Rizk

Dr. Rizk’s rhinoplasty regimen consists of numerous treatments and medications, intraoperative techniques and postoperative treatments and medications.

Prior to surgery, Dr. Rizk suggests his patients take Vitamin C. Preparing for surgery is actually more a matter of avoiding certain supplements and medications. These include Motrin, Advil, Aleve, Excedrin, Bufferin and any other medications and supplements that can thin the blood. Such medications can lead to increased bleeding, and should therefore be avoided for two weeks before surgery.

Dr. Rizk also recommends that his patients avoid alcohol for 48 hours before surgery, and that they stop taking herbal supplements and teas one week before surgery. Smokers should quit smoking a minimum of one month before surgery.

Dr. Rizk uses a unique combination of techniques during surgery (i.e., intraoperative techniques). For example, he uses special tissue glues and dissolvable sutures that eliminate the need for nasal packing and speed up wound healing. For patients with crooked septums, he may use plastic splints. He is also well known for his use of partially closed sutures during rhinoplasty, which allow fluid to drain and lead to less swelling. Finally, Dr. Rizk uses a high-definition 3D telescope to avoid small blood vessels and sensitive tissues, thereby diminishing swelling and bruising.

Postoperatively, Dr. Rizk often prescribes pain-killers and recommends that his patients use herbal supplements such as arnica montana, which may reduce swelling. He also provides rhinoplasty patients with a Vitamin K and medrol dose pack, as well as Bactroban ointment. In some cases he recommends manual lymphatic draining for his rhinoplasty patients.

Dr. Rizk uses a number of special surgical technologies and techniques that promote rapid recovery. The combination of these methods is unique to Dr. Rizk.

One of the keys to the rapid recovery experienced by Dr. Rizk’s patients is his use of a high-definition 3D telescope. This allows for smaller incisions and greater precision. By using the 3D telescope Dr. Rizk is able to get a better view of small blood vessels and tissues that when disturbed may cause bruising and swelling.

Another element that makes Dr. Rizk’s rapid recovery regimen unique is his use of special tissue glues and dissolvable sutures inside the nose. These aid the healing process by eliminating the need for nasal packing, which can disturb nasal tissues and lead to prolonged swelling. Dr. Rizk pioneered a technique whereby he only partially closes the incisions. This revolutionary method, which allows for natural drainage and prevents blood and fluid from collecting under the skin, is unique to Dr. Rizk’s rapid recovery program. The incisions self-seal within about five days.

Dr. Rizk also uses a unique sculpting technique that contributes to rapid recovery. Specifically, he sculpts at a deep level of the muscle layers, where there are fewer blood vessels. This “clean plane” approach reduces bruising. Moreover, sculpting at this deep muscle layer that is above the cartilage and bone eliminates harsh edges and softens the nose’s shape, resulting in a more natural look.

Amazingly, patients who undergo rhinoplasty with Dr. Rizk’s unique rapid recovery program typically look presentable within five days.

In the March/April 2013 issue of Modern Aesthetics Magazine, Dr. Rizk shared his outlook on the future of rhinoplasty in his article, “A 21st Century Approach to Rhinoplasty: A Marriage of Form and Function.” According to Dr. Rizk, a modern nose job preserves the overall characteristics of the original nose, making small alterations to straighten or refine the overall shape. Dr. Rizk’s highly natural approach ensures that his rhinoplasty work stands the test of time, simply creating a greater harmony with the nose and the rest of the facial features. His use of advanced 3D high-definition technology also increases surgical precision, resulting in reduced swelling, bruising, scarring and recovery time.

Dr. Rizk is able to achieve a rapid recovery after rhinoplasty thanks to a combination of instructions given to his patients, the techniques he performs and the medications and remedies he prescribes.

Prior to surgery, Dr. Rizk instructs his patients to avoid anything that might thin out the blood — which can increase the chance of excessive bleeding and prolonged recovery — for two weeks prior to and following surgery. This includes but is not limited to aspirin, Motrin, Advil, garlic, fish oil, and herbal teas and remedies such as gingko biloba and St. John’s wort. Let Dr. Rizk know if you are taking any prescription or over-the-counter medications so he can advise you.

Dr. Rizk also asks his patients to avoid alcohol for 48 hours before surgery, as it too can increase the risk of bleeding, as well as swelling. Finally, he insists that smoking be avoided for any number of reasons, but one of them is that it interferes with healing and therefore can prolong the recovery period. Dr. Rizk recommends that his patients use arnica montana (a natural plant extract) prior to surgery to help reduce swelling.

Actions Dr. Rizk takes during the rhinoplasty procedure also play a role in his patients’ rapid recovery. For example, he uses certain tissue glues as well as dissolvable sutures in order to avoid the need for packing, which can cause undue bruising and swelling. He has also pioneered a suturing technique in which the sutures are not fully closed; this allows fluid to drain between the stitches, reducing the severity of swelling and leading to far more rapid recovery than with tightly closed incisions. It also eliminates the need for drains that can prolong recovery.

In addition, Dr. Rizk’s use of a high-definition 3D telescope helps his patients achieve rapid recovery following rhinoplasty. The scope allows Dr. Rizk to avoid disturbing small blood vessels and sensitive tissues, which might lead to increased swelling and bruising.

Dr. Rizk takes a number of postoperative measures to ensure rapid recovery. He advises his patients to continue taking arnica montana pills, and he gives them a Vitamin K and Medrol dose pack, as well as a kit with several medicines that can help speed up their recovery. In some cases, Dr. Rizk recommends manual lymphatic drainage massage to help his patients recover more rapidly. He always advises his patients that they must avoid smoking at all costs.

It is important to follow all of Dr. Rizk’s postoperative instructions carefully to achieve a rapid recovery.

This depends on the patient and on how the drug use affected him or her, particularly his or her nose. Intranasal use of certain drugs – namely cocaine – can cause major damage to the nose. However, many former drug users who have not suffered this type of damage are suitable candidates for rhinoplasty.

Intranasal drug use decreases the supply of blood to nasal tissues, which can lead to the destruction of septal cartilage, and sometimes, septal perforation (holes in the septum). This in turn can compromise the nasal bridge support. When this occurs, a septal perforation repair may be necessary, which is not always successful due to diminished blood supply. Additionally, the lack of support creates a cartilaginous saddle nose deformity which requires repair with a rhinoplasty with grafts. The repair of saddle nose has a high success rate.

Intranasal drug use can also thin or scar the mucosa that covers the septum; in some cases this makes septoplasty inadvisable, due to increased risk of tearing the septum and creating a septal perforation.

If you are a former drug user, it is very important that you tell the surgeon evaluating you so that he or she can make the right determination regarding your potential surgery.

Also, it goes without saying that continued intranasal drug use is a bad idea, especially during the healing period, which can last up to a year. Taking drugs intra-nasally during the recovery period could have a catastrophic effect on your results.

Rhinoplasty surgeons use a variety of methods to determine the correct shape of a patient’s nose. They often start by analyzing a patient’s facial proportions and facial symmetry, and by looking at the airway to determine if it is properly positioned. Rhinoplasty specialists also rely on mathematical formulas and on medical studies; there are a number of published rhinoplasty studies that have assessed thousands of patients from various ethnic backgrounds.

In fact, ethnicity is one of the most important factors in determining the correct shape of a patient’s nose. Noses vary greatly by ethnic group. For example, a Caucasian nose usually does not look good on a non-Caucasian face. So if you look more like J.Lo, you shouldn’t be asking for Angelina’s nose. If you are considering rhinoplasty, your surgeon will consider your preferences, but make sure to listen closely to your surgeon’s advice.

Rhinoplasty is a complex, invasive surgery that requires tremendous skill and knowledge. It is extremely important that you choose a rhinoplasty specialist with extensive experience and proven success performing rhinoplasty on people of your ethnic group, and on people who look like you. Ask your prospective rhinoplasty surgeon for before and after photos, and look for patients that look like you. Do you like the results? Does it look like the surgeon chose the correct nasal shape? If not, you may need to consider another surgeon.

The reason it may take a full year to see final rhinoplasty results is swelling. All rhinoplasty patients experience swelling, and this can take up to a year to subside. The tip of the nose is usually the area where swelling lasts the longest.

The degree of swelling depends on the techniques used during your rhinoplasty procedure, and on the resulting trauma to your nasal tissues and structure. If bones need to be broken or if large amounts of tissue are excised and/or lifted, you are likely to experience more swelling, bruising and other postoperative symptoms. The “open” rhinoplasty technique, whereby an incision is made in the skin at the base of the nose between the nostrils (the columella), is associated with more swelling and other postoperative symptoms than the “closed” procedure.

You can encourage faster healing by following your rhinoplasty surgeon’s postoperative instructions carefully, especially those pertaining to swelling. This may include the use of cold compresses, prescription and/or over-the-counter medications and natural remedies such as Bromelain or Arnica Montana. You should also take care to avoid bumping your nose, which can damage the results and prolong the healing process. Also avoid the sun for six weeks, as sun exposure can interfere with healing.

Note that certain anatomical factors, such as thicker nasal skin, may make some patients more susceptible to prolonged swelling, and therefore a longer healing period.

Talk to your rhinoplasty specialist for more information on the recovery process.

So long as your rhinoplasty procedure goes well, the results should last for a lifetime. Aging should not affect the actual results in any way.

However, your nose will continue to age, just like every other part of your face. This can manifest in a number of ways, including skin blemishes from sun damage, larger pores, and larger blood vessels at the corner of the nose. In addition, thanks to gravity, the tip of the nose can lose some degree of projection. This can make the nose look longer in elderly people, some of whom decide to have rhinoplasty surgery in order to correct it.

In the past, older rhinoplasty procedures sometimes compromised the nasal structure, a factor that is very important for lasting results. With modern rhinoplasty techniques, this is no longer the case.

Prior to surgery, some rhinoplasty patients are so focused on their noses that they fail to notice signs of aging elsewhere on the face. Following rhinoplasty, some of these patients begin to notice these signs of aging. However, this has nothing to do the results of their rhinoplasty procedures.

To learn more about the aging process and cosmetic surgery, speak to your surgeon.

Dr. Sam Rizk, the best New York Board-Certified Facial Plastic Surgeon, talks about Teen Rhinoplasty and Plastic Surgery on the Today Show with Mat Laeur. Dr. Rizk discusses reasons behind teens seeking for plastic surgery and how it can improve their physical appearance.

Lead Story: Dr. Sam Rizk, a double board certified facial plastic surgeon, is featured on ABC News (NIGHTLINE) and speaks about reasons behind teen facial plastic surgery. Teens feel that people judge and bully them based on the way they look. They feel that plastic surgery will be a way to cope with these insecurities. &nbsp

The use of herbal remedies following rhinoplasty can be helpful or hurtful. It all depends on the specific herbal remedy and your unique circumstances. It is therefore imperative that you follow your surgeon’s instructions.

Arnica Montana and Bromelain are two of the most popular herbal remedies used following rhinoplasty and other facial plastic procedures.

Arnica Montana is a plant that may reduce swelling following a trauma or a surgery such as rhinoplasty. Many rhinoplasty surgeons, including Dr. Rizk, recommend that their patients use Arnica Montana before and after their nose surgery procedures.

Some surgeons also advise their patients to use Bromelain, a pineapple extract used for the same purpose. However, Bromelain can cause complications in some patients, namely those with digestive conditions, so it is very important that you speak to your surgeon before using this remedy.

Though products containing Arnica Montana and Bromelain may be appropriate for your situation, do not take this to mean that other supplements or herbal remedies are necessarily appropriate for rhinoplasty recovery. For example, Vitamin E, Ginkgo Biloba, fish oil and other supplements can cause issues with bleeding. That being said, there are some others that your facial plastic surgeon might recommend. Talk to your rhinoplasty specialist for more information on taking herbal remedies following nose surgery.

Ethnic rhinoplasty generally refers to rhinoplasty performed on a patient who is not Caucasian. But because each ethnicity has its own set of nasal characteristics, performing nose surgery on a non-Caucasian patient isn’t a matter of taking the “normal” procedure and “balancing” it with ethnic features. Instead, in many cases the procedure is entirely different.

“Ethnic” patients often have thicker skin, a flatter dorsum, a broader nasal base, a lower radix and shorter alar (lower lateral) cartilages. These cartilages are often “weak” as compared to the cartilage in Caucasian noses, and therefore must be treated differently.

The goal of any rhinoplasty procedure is to create harmony, symmetry, and ultimately, beauty. In ethnic patients, this typically means altering the nose and other features in such a way that the results sharpen and define the patient’s features in accordance with his or her facial proportions while preserving the patient’s ethnic characteristics. This frequently entails altering the following characteristics:

• Nasal pyramid
• Dorsum
• Tip
• Pyriform area
• Nasolabial angle
• Alveolar ridges
• Tip projection
• Alar base

Creating harmony between the nose and other features of the face must be undertaken on a case by case basis. Tools such as imaging software can be used to determine the right balance and harmony of an ethnic patient’s facial features.

Talk to your facial plastic surgeon to learn more about how he or she balances ethnic features when performing rhinoplasty.

Your rhinoplasty consultation is your chance to get answers from your facial plastic surgeon about your most pressing questions regarding nose surgery. During your consultation, you will have the opportunity to ask your surgeon questions about his or her experience, training, board certifications, techniques and other background information that will help you decide if he or she is the right surgeon for you.

Most rhinoplasty specialists also ask their patients to bring photographs of noses they like. Depending on your ethnicity and unique nasal characteristics, your surgeon may or may not be able to mimic the look you’re interested in. During the consultation you will go through the photographs and other images, and discuss the possibilities with the surgeon.

Your prospective surgeon will also want to discuss your medical history and any medications or supplements you are taking.

In addition, the facial plastic surgeon will explain the surgical options and provide detail about the procedure. He or she will also touch on factors such as potential side effects and recovery, and may suggest additional procedures that might complement the procedure, such as a chin implant, or combining rhinoplasty with septoplasty. 3D imaging may be used to give you an idea of how the procedure is performed and what the results might look like. The surgeon will also provide you with pre- and post-operative instructions.

In the end, your rhinoplasty surgeon will need to assess whether or not you’re a good candidate. If you are in good overall health and have realistic expectations, chances are you’re a good candidate for nose surgery.

Dr. Sam Rizk featured in Tatler Magazine’s Beauty & Cosmetic Surgery Guide 2013

Dr. Sam Rizk discusses the popularity of ethnic rhinoplasty, the dangers behind unlicensed practitioners and botched operations in the black market.

Smoking and drinking will not make a straight nose go crooked or have any other direct effect on the results of a rhinoplasty procedure. However, smoking and drinking can both interfere with healing, and therefore may indirectly affect the results.

The primary reason smoking affects healing is that cigarettes contain nicotine, which causes vasoconstriction, in turn “choking off” the flow of blood to vessels in the nasal skin. In the postoperative period, the nose relies on these vessels for healing. Vasoconstriction can also lead to infection. Moreover, smoking can lead to prolonged postoperative swelling — not to mention cancer. If you’re currently a smoker, it’s a good idea to quit anyway; but if you want to have rhinoplasty, it’s an absolute must.

Alcohol consumption can interfere with healing due to vasodilation. It can also lead to fluid retention and therefore excess swelling. Many facial plastic surgeons advise their patients to avoid alcohol for a week and reduce alcohol intake for about a month. Also, it is very important to avoid bumping your nose for six to eight weeks — so be careful with the cocktails.

Depending on your unique medical history and circumstances, there may be additional reasons for you to avoid smoking and drinking alcohol after your rhinoplasty. Speak with your surgeon to learn more.

Some patients who visit Dr. Rizk have relatively minor aesthetic issues with the tips of their noses, and therefore do not need to undergo complex rhinoplasty procedures. For this reason, tip refinement is sometimes referred to as “rhinoplasty light.” In many cases, a minor refinement procedure can go a long way.

The appearance of the nasal tip depends largely on the lower lateral cartilages. Tip refinement techniques often concentrate on refining this cartilage in order to reshape the nasal tip. The surgeon will decide what approach to take with the cartilage depending on the specific needs of the patient. In some cases a small sliver needs to be removed; in others, the cartilage needs to be “scored” or “morselized” (crushed) before removal.

Usually, the facial plastic surgeon uses a combination of techniques, such as removing some cartilage and utilizing internal suture methods; this allows the surgeon to rotate, enlarge, narrow or otherwise modify the nasal tip. In some cases, cartilage grafts may be used to achieve elevation.

The techniques used in tip refinement depend on the ultimate aesthetic goal of the procedure. For example, some patients require upturning or elevation of the tip. It depends on whether the patient’s nose is too boxy, too bulbous or too wide prior to surgery.

Your facial plastic surgeon will use tools such as computer imaging to demonstrate what the various tip refinement techniques can accomplish. For more information on tip refinement techniques, speak to your rhinoplasty specialist.

Dr. Sam Rizk notices a significant increase of men in their 20s and 30s getting rhinoplasty, chin implants, and chin contouring procedures at his NY Facial Plastic Surgery Center. The trend of men interested in cosmetic enhancements are due to the pressure of needing to look youthful in order to compete in their respective fields and the constant stigma to look good, says Dr. Rizk.

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Alar batten grafts are grafts used to strengthen the nasal airways in order to prevent alar retraction or to treat nasal valve collapse. They can also be used to treat a “pinched” nasal appearance. “Alar” refers to the nasal ala while “batten” is a nautical term that means to stiffen.

In cases of nasal valve collapse, alar batten grafts are used when the nasal sidewall is collapsed, causing narrowing of the nasal valve that may lead to breathing problems.

Alar batten grafts are placed in pockets just above the lower lateral cartilages. They may be made of costal, septal or conchal cartilage. Conchal is the least sturdy of these and is therefore not the best option for some patients.

In certain cases alar batten grafts may be combined with septoplasty or septorhinoplasty.

Roughly 10-15 percent of rhinoplasty patients are dissatisfied with their primary rhinoplasty nationwide and seek revision rhinoplasty, also known as secondary rhinoplasty. But is it harmful to undergo multiple revision rhinoplasties? It depends on a number of factors.

First and foremost, it is important to note that it depends more on what was done in prior surgeries, and on factors specific to your anatomy, than it does on how many rhinoplasty procedures you have undergone. Factors that must be considered by you and your surgeon include the following:

• Integrity of the nasal skin
• Thickness of the skin (if you have naturally thin skin or if it’s thinner due to prior rhinoplasty procedures, the risk of undergoing additional procedures may be too high)
• How much cartilage was removed
• Whether you need skin grafting
• Amount of scar tissue
• Extent of deformities
• Psychological condition of the patient

Revision rhinoplasty is very technically challenging, so even one revision should not be taken lightly. For this reason, it is also imperative that you select a facial plastic surgeon specializing in revision rhinoplasty to perform any additional revisions.

Also, it is very important that you have realistic expectations. With each successive procedure, the odds of a successful outcome diminish. The only way to know for sure is to get an evaluation from a qualified revision rhinoplasty specialist.

Dr. Sam Rizk comments on Duchess of Cambridge Catherine Elizabeth “Kate” Middleton’s nose. Dr. Rizk says “Kate is a natural beauty. Her nose has a good shape, looks like she was born with it, has no visible irregularities (even in tabloid close ups) and no hump or asymmetries,” and “It is not too large, too small, or too chiseled, and most importantly, it suits her face and complements her other features.”

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